中国城镇基本医疗保险肝细胞癌住院患者的治疗方式及医疗费用研究

Inpatients' Treatment Patterns and Hospitalization Expenditure for Hepatocellular Carcinoma Among Population with Urban Basic Health Insurance in China

目的:描述中国城镇基本医疗保险参保者中肝细胞癌患者在住院期间的治疗方式及医疗费用,并探析该类患者2008-2010年的住院医疗费用变化趋势。方法:采用中国城镇基本医疗保险住院患者数据库,选择2008-2010年18岁及以上城镇职工及居民肝细胞癌患者2765例住院人次,对其治疗方式(基于卫生部2011年诊疗规范分类)、医疗费用及住院天数进行描述性统计分析。结论:中国城镇基本医疗保险肝细胞癌住院患者的治疗模式多样。最常用的治疗方式是系统治疗和介入治疗。系统治疗中的中药治疗作为辅助治疗被广泛应用,系统化疗也为该类方式中最常用的方法之一。肝细胞癌的治疗费用从2008年到2010年明显增加,住院天数明显下降,但日平均费用明显上升。所采用的治疗方式中,肝切除术的费用最高,而姑息治疗的费用最低。

OBJECTIVES： This study was to describe current hepatocellular carcinoma （HCC） treatment patterns and healthcare expenditures during hospitalization among China＇s urban basic health insurance （BHI） beneficiaries, and the trend of indirect medical cost of HCC hospitalization from 2008 to 2010. METHODS： This was an encounter-based retrospective study using urban BHI claims database from 2008 to 2010 （2,765 hospitalizations due to HCC）. Study subjects were those HCC inpatients aged 18 years and older, with the China urban citizens＇ or employees＇ BHI plan. Descriptive statistical analyses were conducted for treatment patterns （based on the Ministry of Health of China＇s 2011 good practice of liver cancer diagnosis and treatment）, expenditures, and length of stay. CONCLUSIONS： Various treatments were used by hospitalized HCC patients among urban BHI enrollees. The most often used treatments were systemic therapy and interventional therapy. The TCM was usually used as an adjuvant therapy, and systemic chemotherapy was also commonly used. However, the health outcomes （such as overall survival and profession-free survival） associated with the various treatment patterns are unclear and thus need to be investigated further. The HCC treatment costs increased greatly from 2008 to 2010, while the length of stay decreased. The daily cost increased largely. Cost of liver resection was the highest while cost of palliative therapy was the lowest.